Strategies to Eradicate Dog Mediated Rabies By 2030

INTRODUCTION
Rabies is one of the oldest zoonotic disease known to mankind. In Sanskrit, the term rabies means ‘to do violence’. The threatful disease is causes by the Lyssa virus, which comes under the family Rhabdoviridae. The word lyssa, a Greek etymology, adds more meaning to the clinical feature of the virus, as it indicates the madness experienced by the affected dog. The virus can spread to people and pets if they are bitten or scratched by the rabid animal.

All the warm-blood animals are susceptible to rabies virus. Some of them include wolves, coyotes, hamsters, rabbits, cats, dogs, primates, and even the flying mammals. But mostly dogs are associated closely, and are responsible for 96% of humans rabies cases in South-East Asia, although some cases of bat borne infections are constantly reported in the US.

WHY RABIES IS A THREAT?
Almost 59,000 people die of rabies every year in the world, and about 30 to 50 percent of dog mediated rabies cases are from India. The statistics clearly shows that for every 2 seconds, a person gets bitten by the dog, and death happens while counting every 30 minutes due to lack of efficient treatment. The most bewildering and downhearted part is when the patients develops the symptoms of rabies, there wouldn’t be a better treatment at the time. Hence, we have to remember this with a red flag,

                                    “Rabies is 100% fatal and 100% preventable”

HOW DOES THIS CAUSE DEATH  TO AN INDIVIDUAL
Rabies virus have tendency to attack the nervous system, and so it is a neurotropic virus. It moves into the CNS by retrograde axoplasmic force. The primary replication occurs in the muscle fibre at the site of bite. The virus then aggregates around the proper receptor nerve endings of their acetylcholine receptors, and then centripetal migration takes place. Once after reaching the brain, it also moves to salivary gland by centrifugal movement along the axoplasmic route. It causes fatal encephalitis with wide course of clinical signs. The incubation period is long and is about 25 to 90 days.

As the diseases progresses, the person may experience delirium, abnormal behaviour, hallucinations, hydrophobia (fear of water), and insomnia. The acute period of the disease can be up to 10 days. However, once the rabies symptoms appear, the disease will be always fatal, and so no treatment is possible at this stage. Human-to-human transmission through cornea or organ transmission is possible, but fortunately very rare.

WHAT TO KNOW ABOUT RABID DOG?
Dogs can transmit the virus 3 to 7 days before exhibiting clinical signs. Their clinical signs are generally characterized by two forms – furious (acute neurologic encephalitis) and dumb (paralytic). The furious form is manifested by restlessness, hydrophobia, excessive Whenever we come across a dog affected with rabies, we just need to report to local animal rescuer or local regional officer. Do not kill the rabid dog as it is suggestive in giving information for the person undergoing treatment. The WHO (World Health Organization) has recommended that the clinically normal dog which has bitten, should be examined for 7 to 10 days to see if it suffers from the virus or not. Also, this virus is of economic importance to farmers as some rabid dog bites the livestock such as goat, sheep, cattle, and chickens.

                            “ Stay calm when you encounter a furious rabid dog”

TACKLING THE VIRUS IS A BIGGEST CONCERN
As there are no prompt treatment after visible symptoms, we have only vaccination as our great hope. Vaccination for rabies was introduced by Louis Pastuer and he had used rabbit brain cords to prepare. Later, all novel methods arose and currently cell culture technique gives the promising outcome. Vaccination against rabies is used in two distinct situations:

• Pre-exposure vaccination ( used for the people who are at risk of getting rabies)
• Post-exposure vaccination (used to prevent the development of clinical rabies after exposure)

The vaccine used in both the cases are same, however the immunization schedule varies. Pre-exposure vaccination should be offered to laboratory staffs working with rabies, veterinarians, animal handlers. It consists of three full intramuscular doses of cell culture or embryonated-egg based vaccine on days 0, 7, and 21 or 28. The vaccine should be administered only in deltoid muscle in the adult. If it is on gluteus, it will result in lower neutralizing antibody titres. Use of chloroquine is not recommended as it will reduce response. This pre-exposure vaccination will definitely be fruitful in treating people once they show clinical symptoms. Just a booster vaccine will do the need for the affected people.

HOW DOES ONE TREAT AN ANIMAL BITE
When the person has contact with the rabid dog, then he/she should definitely require post-exposure prophylaxis. Some of which includes

1. Wound management
   Wounds should be washed and flushed immediately with soap and water for 10-15 minutes. This is the most effective first-aid treatment against rabies. The wounds should be kept open and should not be covered with bandages or any dressing material. Suturing is also prohibited as it may pave way for easy inoculation of the virus. Disinfection with povidone or alcohol is recommended.
2. Active immunization
   Cell culture vaccines are used for the victims to lower the effect of the virus. They can be given either intramuscular or intradermal route. Both a five-dose and a four-dose regimen are recommended for post-exposure vaccination. The five-dose regimen is administered on days 0, 3, 7, 14, and 28 into the deltoid muscle. The four-dose regimen is administered as two doses on days 0, and then one doses of each of days 7 and 21 into the deltoid muscle.
3. Passive immunization
   Human rabies immunoglobulin (HRIG) or equine rabies immunoglobulin (ERIG) or F(ab)2 products should be used for category 3 exposures, and also it is the last hope for the victims. Passive immunization should be administered just before or shortly after administration of the first dose of vaccine given in the post-exposure prophylaxis regimen.
   Dose for HRIG- 20 IU/kg body weight
   Dose for ERIG and F(ab)2- 40 IU/kg body weight

THE TARGET OF ZERO BY 2030
The ultimate aim of every country is to completely eradicate rabies in their locality. The WHO, OIE, FAO, and GARC are all setting up platform to reach the goal, and trying to form a separate guideline, that demands the whole world to pursue. The reason behind the move is as follows

• It strengthens health system, and also make sure that all people in the world are accessible to medicines, vaccines, necessary kits.
• It promotes coordination with human and veterinary health system.
• It helps to create awareness to the people about the infectious zoonotic disease so that the people will follow the standards said by the officials.

Countries like India should eliminate rabies like disease as it demands more money allotted for it, and also reduces the nation’s economy. Although societal changes are needed to reach Zero by 30, achieving zero human rabies in India is technically feasible. Educating people will definitely create impact on the society, and it is one of the essential need to eliminate the virus. After then, evaluation and monitoring of the disease seeks importance.

HOW TO ATTAIN THE GOAL
It is possible to eliminate rabies by 2030 if we have apt strategic plan in the country. It includes certain measures that ought to be taken by the government.

1. Awareness
   Developing skills to identify the disease at the early stage of infection, and also make the people more aware and cautious about the disease is necessary to the fullest.  This includes an understanding of how to prevent rabies in animals, when to suspect rabies, and what to do in case of a bite. This kind of information is carried to people through

• Mass vaccination campaigns
• Quiz competitions
• Marathons
• Conferences
• Media interviews
• School visits

3. Post-exposure prophylaxis
   It consists of series of rabies vaccines and,  in some cases, rabies immunoglobulin can be administered. Appropriate wound management, and prompt access to quality-assured PEP is almost 100% effective in preventing human rabies death.
4. Mass vaccination of dogs
   It is the most cost effective way to save human lives by gradually reducing the transmission from its source. We already saw that the dogs are responsible for more than 96% of human cases, and so containing the disease in the host is utmost important.  Some studies also proved that sustained vaccination in dog population were keys to reduce the possible human cases. Therefore, we need to focus more on dogs and get them vaccinated to slow down the spread to humans.

Theme for 14^th World Rabies Day 2020

“End rabies: Collaborate, Vaccinate”

The name itself clearly suggests the importance of vaccination and support of the people in view of eradication of the disease. Vaccination of dogs is of immense need to effectively control the virus. Although sylvatic cycle seems dangerous, we need to focus on the dog available in the society. Vaccine is a key component and must needed outlook of this area helps to recreate the happy faces among the people. Establishing human and dog biological banks are useful in collecting data and some quality products. Another method to adopt is to generate, innovate and measure impact through policies, guidance and governance, and reliable data to enable effective decision-making.

“Vaccination of dogs plays a key part in creating a rabies-free India”

Conclusion
Reaching zero by 30 will mean children that live, adults who work, and families who stay together. It will enable the future perspective of resources and effective utilization of it. The goal to achieve rabies free India will render everyone safe, and further enhances the adoption of dogs among the pet lovers. Improvement in the medical facility will make patients happy if they are diagnosed with other diseases. Fear about the rabies will decline when the goal succeeds.

“Let’s be responsible and stay united to eliminate the deadly rabies virus possibly by 2030”